Transzygomatic coronoidectomy as a treatment for pseudoankylosis of the mandible after transtemporal surgery.

Pseudoankylosis of the mandible after a transtemporal operation is rare. In patients with severely limited mouth opening, a transzygomatic approach is the approach of choice. We report a case of pseudoankylosis of the mandible that was successfully treated by transzygomatic coronoidectomy.

Retrospective outcome analysis of temporalis muscle transfer for the treatment of paralytic lagophthalmos.

Temporalis muscle transfer for paralytic lagophthalmos, which was first proposed by Gillies and later developed by Andersen, has been one of the most common treatment modalities for paralytic lagophthalmos. However, there have been no scientific reports statistically analysing the efficacy of temporalis muscle transfer. We, therefore, retrospectively analysed the functional and aesthetic results of temporalis muscle transfer. Between 1994 and 2006, we carried out temporalis muscle transfer (the so-called Gillies-Andersen method) on 95 established facial paralysis patients. We sent a postal questionnaire to these patients and 47 of them responded. The functional and aesthetic results were analysed based on the patients' replies together with clinical records and photographs, and unfavourable factors of this procedure were investigated. After surgery, most ocular symptoms (mechanical irritation, dry eye, soreness, and discharge) improved significantly. Achievement rate of complete eye closure was 78.7%. A morphometric study revealed that possible unfavourable factors (old age, intracranial disease, use of dentures, etc.) did not affect the achievement rates of complete eye closure. Deformity of eyelid fissure due to undue tension of the temporal fascia fixation was found in nine patients (19.1%) and six of these patients underwent secondary revision. Unlike lid loading with a gold implant, the results of temporalis muscle transfer depend greatly on the surgeon's skill. However, if this procedure is performed properly, strong eye closure can be obtained. We, therefore, recommend temporalis muscle transfer as the preferred option for reconstruction of paralytic lagophthalmos.

Choice of osseous and osteocutaneous flaps for mandibular reconstruction.

Microvascular free flap transfer currently represents one of the most popular methods for mandibular reconstruction. With the various free flap options now available, there is a general consensus that no single kind of osseous or osteocutaneous flap can resolve the entire spectrum of mandibular defects. A suitable flap, therefore, should be selected according to the specific type of bone and soft tissue defect. We have developed an algorithm for mandibular reconstruction, in which the bony defect is termed as either "lateral" or "anterior" and the soft-tissue defect is classified as "none," "skin or mucosal," or "through-and-through." For proper flap selection, the bony defect condition should be considered first, followed by the soft-tissue defect condition. When the bony defect is "lateral" and the soft tissue is not defective, the ilium is the best choice. When the bony defect is "lateral" and a small "skin or mucosal" soft-tissue defect is present, the fibula represents the optimal choice. When the bony defect is "lateral" and an extensive "skin or mucosal" or "through-and-through" soft-tissue defect exists, the scapula should be selected. When the bony defect is "anterior," the fibula should always be selected. However, when an "anterior" bone defect also displays an "extensive" or "through-and-through" soft-tissue defect, the fibula should be used with other soft-tissue flaps. Flaps such as a forearm flap, anterior thigh flap, or rectus abdominis musculocutaneous flap are suitable, depending on the size of the soft-tissue defect.